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Some of the environmental factors that could affect the composition of intestinal microbiota and produce alterations in the immune system are changes in lifestyle, such as taking antibiotics, Western-style diet, and cigarette smoking

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[22] Habitual chewing of areca nuts increases the risk of cirrhosis and hepatocellular carcinoma

Coughing due to heavy smoking can also lead to increased intra-abdominal pressures which may further add to the back pain says Dr Neha Narula, senior spine specialist, QI Spine Clinic, who suggests three important reasons why one should quit smoking immediately

"Pharmacies (in the U.K.) would never sell cigarettes as this does not fit in with their health promoting role," said Amos, who was not part of the new study